Cost-effectiveness of a corticosteroid injection versus exercise therapy for shoulder pain in general practice (SIX-Shoulder Study): a randomized controlled trial.

BACKGROUND: Shoulder pain often results in functional limitations leading to substantial societal and healthcare costs. Guidelines recommend a corticosteroid injection or exercise therapy, but long-term comparative cost-effectiveness remains unclear. This study examined the cost-effectiveness of these two treatments over 12 months in patients with shoulder pain presenting in Dutch primary care. METHODS: A randomized controlled trial was conducted with patients consulting for a new episode of shoulder pain. Participants were randomly assigned to a corticosteroid injection or a 12-week physiotherapist-led exercise therapy program. Participants completed questionnaires at baseline, 6 weeks, and 3, 6, 9, and 12 months. The primary outcome was incremental costs per quality-adjusted life year (QALY) gained over 12 months, analyzed with the incremental cost-effectiveness ratio (ICER). QALY was measured using the EuroQol Five-Dimensional Questionnaire (EQ-5D-5L) score. RESULTS: A total of 183 participants were included, with 91 participants in the injection group and 92 in the exercise therapy group. The incremental costs and QALY for the exercise group were, respectively, €428 (95% CI: -1825 to 2682) and 0.02957 (95% CI: -0.0299 to 0.0891), resulting in an ICER of €14 489 (95% CI: -1 698 053 to 1 727 032) per QALY gained. With a willingness-to-pay threshold of 50 000 the cost-effectiveness acceptability curve showed a probability of 70% of cost-effectiveness for exercise therapy. CONCLUSIONS: For patients with shoulder pain, the exercise therapy group has a probability of 70% to be cost-effective compared to the injection group over a 12-month follow-up with an ICER of €14 489 (95% CI: -1 698 053 to 1 727 032) at a willingness-to-pay threshold of €50 000 per QALY. CLINICAL TRIAL REGISTRATION: registered in the Netherlands Trial Registry (NL-OMON52854).